Infertility is a medical concern just like any other, so activists want to know why it isn’t covered by insurance like any other.
Barbara Collura
President and CEO, Resolve: The National Infertility Association
Barbara Collura of Resolve: The National Infertility Association, argues that infertility and fertility treatments are reproductive healthcare in the same way that pregnancy prevention is reproductive healthcare. So why have medical procedures to treat infertility in both women and men, such as in vitro fertilization (IVF) been ignored when it comes to insurance coverage?
For whatever reason, fertility treatments haven’t been widely viewed as medically necessary. “The ability to get pregnant and carry a pregnancy to term, I would argue, is a very key part of reproductive health,” Collura said. “I mean, that’s what reproduction is.” Collura pointed out that when any other system in your body isn’t functioning, you can get treatment covered by insurance no problem.
“If your your cardiac system isn’t working, you’re going to go to a cardiologist and you’re gonna get treatment, and it’s gonna be covered. So why is it that the reproductive system isn’t the same way, when it’s not working properly and you go to the doctor and there’s medical treatments that can help you? Why wouldn’t that be covered?”
IVF has been around for decades, and is known to be common, safe, and effective. Yet because of the high costs associated with it, it is only easily accessible to a small segment of the population. This also leads to misguided perceptions about which demographics are most affected by infertility.
“Because this isn’t widely covered by insurance, the people who are able to access it are the ones who have the out of pocket funds to cover it,” Collura said. “And so, you have this view of who is infertile as being a middle to upper middle class, perhaps white, perhaps urban, woman. While I’m not saying that those women don’t have infertility, they are not the only ones that have infertility.”
And there are large demographics who need options outside of IVF, such as single people, same sex couples, or people who are prevented from getting pregnant due to health issues like uterine cancer. Donor sperm, intrauterine insemination, and gestational carriers are all medically viable options for these populations. “Why shouldn’t everyone have the right to build a family?”
When confronted with the argument that adoption is a more feasible choice, Collura described this as a false dichotomy that doesn’t address the larger issues.
“Adoption is really about child welfare, and it’s not the responsibility of the infertile to solve the child welfare problem. And so that old phrase ‘just adopt’ is just really offensive.”
Not to mention, adoption is often likewise an expensive and arduous process and, as Collura pointed out, some states have laws that can be discriminatory toward would-be adoptive parents, perhaps against a same-sex couple or based on a person’s religion.
So, what is there to be done?
Collura’s organization is focused on getting fertility covered by insurance across the board, and they are attacking this goal on multiple fronts. The first and most basic effort is raising awareness and encouraging individuals to fight for insurance coverage in their own workplaces.
“We have a program called Coverage at Work and what we are trying to do there is motivate employees to advocate within their companies for coverage.” Collura said that in the same way the organization advocates in Congress, they are trying to motivate individuals to argue for this coverage in their own HR departments.
“We really feel that bottom up employee advocacy approach will really make a difference with employers,” she said, explaining, “You’ve got employer’ being pressured by their employees to add it, and then they’re gonna go to insurers, and they’re gonna say, ‘I need to add this coverage.’”
Like any other big, systemic goal, getting fertility covered by medical insurance as a matter of course isn’t going to be easy and it takes a village. But Collura stressed that reaching out as an individual can be hugely gratifying and personally beneficial.
“For many of us, going through infertility is very isolating,” she said. “But also you feel like you lose control completely. And a lot of us when we advocate — whether it’s with your employer or with a legislator even just telling your story — people feel very empowered. They feel like, ‘I grabbed a little bit of control back.’”